Our story begins Friday morning after breakfast, with M suffering violent cramps and debilitating pain. We were able to get hold of Dr. Santiago quickly who agreed to see her at 11:30. He took x-rays and we saw an obstruction very clearly, but of indeterminate origin. He had his driver take us directly to Country 2000 Hospital in Guad. We were admitted and they began the prescribed treatment for obstruction.
For Friday and all day Saturday the treatments proceeded, but with little efficiency. None of the treatments were able to be kept down long enough to do their job, and, frankly, this was a 36 hour period for her that was difficult in extremis. By Sunday, there was concern over the lack of progress, and even though her treatments had not given the ideal conditions for a colonoscopy, it was decided to do one Sunday night.
The colonoscopy was not able to advance very far, as it very quickly ran into a clear obstruction, with the aperture looking like it was not more than one third to one quarter open relative to the aperture an inch down the Colonic Highway. It also looked under stress, as if it was twisting itself into a knot, called torsion. This presented as a big problem. Then, later Sunday night, the team of doctors decided to go a step further , and using a dye injected liquid, did a CT to further study the obstruction. The radiologist was part of the team, and showed that a number of fibrous threads were encircling the colon, and basically strangling it closed, like some Michael Crichton sci-fi novel. We could see the pictures of the threads and how threatening they were. This moved the surgery decision up, and the team decided on 7:00 a.m. surgery. All this was taking place on a Sunday night not unadjacent to midnight.
Another difficult evening but a team arrived shortly after 7:00 to prep and take her off. I walked with her to the OR, and despite her physical struggles during the evening, she smiled wanly and seemed happy to get on with it.
The surgery proved both interesting and very timely. Once inside, the plan was to try and cut the threads, and if that didn’t work, to do a colectomy, which would cut out the colonic area under attack, and staple it together. But what they found was the essence of this saga. They found that the transverse colon obstruction was in fact not the root cause of the problem. Many colonic feet away, in the cecum area near the appendix, was an internal hernia (not to be confused by the name hernia, it is an unwelcome growth in the colon pushing through a wall weakness or some other portal). This hernia, which was speculated it had worked through an old scar from an appendix operation of who knows how many years past, and does not occur in current appendix operations. For reasons known only to the hernia, it decided to send out these spider web like threads that were attacking the colon. This condition is extremely rare, and is rarely considered during diagnosis. It is not identifiable by any test or scan available, it is obscure, it presents like a standard obstruction diagnosis, and is dangerous to the point that misdiagnosis or missed diagnosis, which is not uncommon, leads to a swift and dire conclusion.
They decided on site to cut out the threads at the source, leave the scar untouched, eliminate the colectomy, and sewed her up.
M was returned to her room and is undergoing recovery. She will be given nutrition for several days by IV in order to give her organs a chance to get back in sync. We don’t really know how long this has been developing, so we don’t know how quickly things will work their way back to normal. But so far, the doctors are pleased with her progress, and as of this writing, we shall try a bit of walking, albeit burdened down by a surfeit of tubes and feeders. This will be her most important recovery tool for a while. Her son Michael arrives Wednesday, and we hope to have her home in Ajijic Friday. Nurse Lydia will provide in house care giving, probably for the first week, but to be determined as we go along. As much walking as possible will aid in her recovery which so far looks good. Color has returned to her cheeks, her spirits are so much improved, and she naps frequently and rests a lot, which is, of course, very beneficial. It is so very wonderful to see her slowly returning to her normal self.
I would be remiss if I didn’t finish this narrative without kudos to the medical team, corralled by Dr. Santiago Hernandez (Chapala Med) , including nurses, specialists, surgeons and radiologists, who worked tirelessly through late on a Sunday night and then early again Monday morning, to bring about the diagnosis, plan, and execution. This is a very dangerous medical condition, and their great effort ensured that the dire consequences did not occur.
Muchas gracias, todos.
DN
